INSTRUMENTS Veterinary Surgical Nursing Surgical Instruments INSTRUMENTS Relevant

































































































- Slides: 97

INSTRUMENTS Veterinary Surgical Nursing Surgical Instruments

INSTRUMENTS Relevant Learning Outcomes Commonly used instruments 1. Identify 2. Describe usage 3. Maintain

INSTRUMENTS What’s in a name? - Mayo • Mayo Family- American doctors of early 1900’s • founded renowned Mayo Clinic in Rochester, Minnesota, USA. • Today 500+ doctors at this clinic

Metals INSTRUMENTS • Surgical Stainless steel – Ideal metal for most instruments • Tungsten carbide – Used for inserts where strength and durability important • Chrome plated carbon steel – Cheap, but blisters and corrodes easily

Needle Holder e. g. Mayo. Hegar INSTRUMENTS Tips Jaws Box lock Shank Ratchet Ring handle

INSTRUMENTS Needle Holder Functions • Hold needle • Tie knots

INSTRUMENTS Needle Holder Features Optionally – Scissors • For cutting sutures • But can accidentally cut suture! – Ratchet • For more secure grip • But can get ratchet caught in gloves

INSTRUMENTS Needle Holder Types • 4 types Gillies Olsen-Hegar Mayo-Hegar Mathieu/Mc. Phails

INSTRUMENTS Needle Holder Types • 2 kinds of Hegars – not Hägars! Olsen Mayo

Needle Holders INSTRUMENTS • What does your practice have? • What would you prefer?

Scissor Uses • • Heavy dissection Fine dissection Sutures Bandages INSTRUMENTS

Scissor Features • Blades – Straight – Curved • Tips – Round only (=Blunt) – Sharp only – Combination of Round & Sharp • Edges – Plain – Serrated INSTRUMENTS

Scissor Types • • INSTRUMENTS Heavy dissection (Mayo) Fine dissection (Metzenbaum) Suture removal Dressing

Mayo Heavy dissection INSTRUMENTS

Metzenbaum Fine dissection INSTRUMENTS

Suture removal Sharp. Blunt INSTRUMENTS Notched

Dressing scissors INSTRUMENTS

Forceps • • Thumb (tweezers) Tissue Haemostatic Intestinal clamps Bone holding Sponge-holding Syringe-holding INSTRUMENTS

INSTRUMENTS Thumb Forceps (tweezers) • Plain – Delicate tissues (e. g. viscera) – Dressings • Toothed – Skin & Connective tissue • • Single row of teeth (dissection) Pad of teeth (wound closure) Long Mesh of teeth (holding vessels) Curved row of teeth (holding needles)

INSTRUMENTS Thumb Forceps – Plain Dressing

INSTRUMENTS Thumb Forceps – Rat-tooth Rats Teeth?

INSTRUMENTS Thumb Forceps – Tooth Pad of teeth (Brown. Adson) Rat tooth heavy Rat tooth fine (Adson) Long Mesh of teeth (De. Bakey)

INSTRUMENTS Thumb Forceps – Tooth Russian

Tissue Forceps Have Ratchet grips INSTRUMENTS

Tissue Forceps 2 kinds – Toothed type (Allis) – Bar type (Babcock) INSTRUMENTS

Tissue Forceps Allis Babcock INSTRUMENTS

Tissue Forceps Always cause some trauma – But OK on tough tissues (fascia) INSTRUMENTS

INSTRUMENTS Haemostatic Forceps • Used to compress blood vessels • If curved – point curved tips up to pass ligatures

INSTRUMENTS Haemostatic Forceps • Transverse grooves – Small (Mosquito) – Large (Crile, Kelly, Rochester-Pean) – Plus rats teeth (Rochester-Ochsner) • Longitudinal grooves – Large (Rochester-Carmalt) • Less likely to slip on large bundles • Recommended for ovarian pedicles (spays)

INSTRUMENTS Haemostatic Forceps Mosquito – small

INSTRUMENTS Haemostatic Forceps Crile – Fully grooved jaws

INSTRUMENTS Haemostatic Forceps Kelly – Partly grooved jaws

INSTRUMENTS Haemostatic Forceps Rochester-Carmalt – Longitudinally grooved – For strong but soft grip on large pedicles (spays)

INSTRUMENTS Haemostatic Forceps Angiotribe – Longitudinally slotted – For strong grip on large pedicles (large animals)

INSTRUMENTS Haemostatic Forceps Rochester-Ochsner – Extra grip on tips

Intestinal forceps Doyen clamps – Used to stop leaks from cut ends of intestines – Not as good as an assistants fingers ! INSTRUMENTS

INSTRUMENTS Sponge-Holding Forceps • i. e. swab forceps

INSTRUMENTS Syringe-Holding Forceps

Towel Clips 2 mechanisms – Ratchet • Backhaus • Roeder – Cross-action spring • Grays • Schaedel INSTRUMENTS

Towel Clamps Ratchet (Roeder) Ratchet (Backhaus) INSTRUMENTS Cross-action (Grays)

Scalpels • Small animal – Flat handle #3 – Blades 10, 11, 15 • Large animal – Flat handle #4 – Blades 20, 21 • Eye surgery – Round handle (Beaver) INSTRUMENTS

INSTRUMENTS Scalpels – Many Types 10 11 15 21 20

INSTRUMENTS Scalpels – Commonly Used Large Animal Small Animal

Scalpel Handles • Large flat handle – Bard-Parker #4 • Small flat handle – Bard-Parker #3 • Round handle – “Beaver” INSTRUMENTS

Retractors • Hand held – – – Senn Army-navy Volkmann Malleable Hohmann • Self retaining – – – Gelpi Weitlaner Balfour Gossett Finochietto INSTRUMENTS

INSTRUMENTS Hand held Retractors Senn

INSTRUMENTS Hand held Retractors Army-Navy

INSTRUMENTS Hand held Retractors Volkmann

INSTRUMENTS Hand held Retractors Malleable – bend to shape

INSTRUMENTS Hand held Retractors Hohmann – Orthopaedics (cruciates, hips) – Also known as “bone levers”

INSTRUMENTS Self retaining Retractors Gelpi – muscle & joint (i. e. orthopaedics)

INSTRUMENTS Self retaining Retractors Weitlaner – fascial

INSTRUMENTS Self retaining Retractors Balfour – abdominal

INSTRUMENTS Self retaining Retractors Gossett – abdominal

INSTRUMENTS Self retaining Retractors Finochietto – Chest

INSTRUMENTS Periosteal Elevators • Used to strip soft tissue (i. e. periosteum) from bone • Handles – many variations • Working ends – a rounded side – a flatter side with a sharp edge

INSTRUMENTS Periosteal Elevators

Bone Curettes INSTRUMENTS • Used to scrape (debride) tissue – Infected bone – Infected tooth sockets

Bone Curettes Examples INSTRUMENTS

INSTRUMENTS Bone Cutting Instruments • • • Bone Shears Bone Chisels & Osteotomes Bone Saws Wire (Gigli) Trephines Rongeurs

Bone shears INSTRUMENTS

INSTRUMENTS Osteotome or Chisel?

INSTRUMENTS Osteotome & Chisel osteotome chisel

INSTRUMENTS Guarded osteotome

Rongeurs INSTRUMENTS • Used to “nibble away” bone or cartilage • Various “actions” – 1 hinge > Single action rongeurs – multiple hinges > Double action rongeurs • Double action provide greater leverage

Rongeurs INSTRUMENTS Examples single action double action

Bone Graft Collection • Methods – Osteotome – Curette – Rongeurs INSTRUMENTS

Orthopaedic mallet INSTRUMENTS

INSTRUMENTS Bone holders – Kern

INSTRUMENTS Bone holders – Kern

INSTRUMENTS Bone holders – Reduction Forceps • These are not towel clamps!

INSTRUMENTS Bone holders – Reduction Forceps

INSTRUMENTS Bone holders – Verbrugge • Bone to plate holders

INSTRUMENTS Bone holders – Lowman

Drilling 1. 2. 3. 4. Air drill Electric drill Hand drill Jacobs chuck INSTRUMENTS

Air Drill • Autoclavable INSTRUMENTS

Electric Drill • Not autoclavable – Requires protective sheath INSTRUMENTS

Hand Drill • Autoclavable INSTRUMENTS

Jacobs Chuck • Autoclavable • For inserting Pins INSTRUMENTS

Wire instruments • Wire passers • Wire twisters • Wire cutters INSTRUMENTS

Wire passers INSTRUMENTS

Wire twisters INSTRUMENTS • These look like needle holders – But shouldn’t use needle holders for wiretwisting!

Wire cutters INSTRUMENTS

Probes Grooved probe for anal sac removal INSTRUMENTS

Spay Hooks • 2 different tips (flat or knob) INSTRUMENTS

Trephines • Bone biopsies • Bone tunnels INSTRUMENTS

Orthopaedic Wire INSTRUMENTS • Cerclage wire – Various gauges – Supplied on spools – 22, 20 and 18 gauges commonly used • Cutting (Gigli wire)

Bone Pins • Large pins > “Steinmann pins” – ¼ to 1/16 inch – Trocar points only – Also called Intramedullary Pins • Small pins > “K wires” & “Arthrodesis wires” – 0. 9 -2. 0 mm – Trocar or Chisel points – Often used as Crossed Pins or ‘Pin & Tension Band’ • External fixator pins INSTRUMENTS

Steinmann Pins INSTRUMENTS • Placed inside bone marrow cavities for fracture repair

INSTRUMENTS Measuring diameters Pins K-wire Drill bits Screws

External fixator • Pins • Rods • Clamps INSTRUMENTS

Bone Screws INSTRUMENTS • Thread type – Cortical – Cancellous • Thread extent – Full length thread – Partial length thread • Thread Raised above smooth shaft (+ profile) • Thread Cut out into smooth shaft (- profile)

Bone Screws • Diameters (mm) – 1. 5 – 2. 0 – 2. 7 – 3. 5 – 4. 5 – 5. 5 – 6. 5 small animals large animals INSTRUMENTS

Bone Screws • Thread extent – Full length thread – Partial length thread • Heads – Hex – Cross INSTRUMENTS

Kick Bucket • Try not to kick it too soon ! INSTRUMENTS

INSTRUMENTS The End

INSTRUMENTS